title: Assuring the optimal use of serotonin antagonist antiemetics: the process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center.
abstract: OBJECTIVE
  The need to foster the appropriate and cost-effective use of serotonin-antagonist antiemetic drugs spurred the creation of guidelines. The process by which institution-wide guidelines at Sloan-Kettering were developed, implemented, assessed, and modified is described.
  
  
  METHODS
  A multidisciplinary group working with disease-specific management teams assigned the emetic potential of chemotherapy programs to one of five categories. Antiemetic regimens, including a specified dose and schedule of a serotonin-antagonist and dexamethasone, were assigned to each emetic category. The information was collated by disease site and chemotherapy program into hospital-wide antiemetic regimen recommendations. Quality assessment was conducted initially and repeated each time the guidelines were modified.
  
  
  RESULTS
  Patient surveys demonstrated a high level of satisfaction with emetic control, which was similar to reported results. Data from the latest survey showed zero emetic episodes in 93% and 87% of participants given moderate and highly emetogenic chemotherapy, respectively. Compliance with the guidelines, initially in 73%, has been improved using a standardized chemotherapy order "check box" labeled, "Antiemetics as per Guidelines." Antiemetic drug expenditures decreased from a projected $2.8 million to $1.3 million annually.
  
  
  CONCLUSIONS
  The guidelines became an educational tool that ensured the delivery of optimal antiemetic therapy chosen by professionals with the greatest knowledge of both the particular chemotherapy regimen and cancer site. Implementation of the guidelines resulted in substantial savings while treating more patients. The guidelines were easily modified as new chemotherapeutic agents and antiemetic drugs became available.
authors.affiliation: Department of Nursing, Memorial Sloan-Kettering Cancer Center and Cornell University Medical College, New York, NY 10021, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nolte
authors.forename: R
authors.initials: R
authors.lastname: Berkery
authors.forename: B
authors.initials: B
authors.lastname: Pizzo
authors.forename: L
authors.initials: L
authors.lastname: Baltzer
authors.forename: D
authors.initials: D
authors.lastname: Grossano
authors.forename: C D
authors.initials: CD
authors.lastname: Lucarelli
authors.forename: M G
authors.initials: MG
authors.lastname: Kris
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D017829:Granisetron / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy; D017294:Ondansetron / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D003907:Dexamethasone; D017829:Granisetron; D017294:Ondansetron; D012702:Serotonin Antagonists